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PubMed1991

[External fixators combined with other methods].

Problems in the treatment of injured persons, especially if lesions of larger organs or organ systems exist, are great. Each method of treatment has some deficiency respectively dark side. In such cases a combination of methods of treatment is a necessity and a rule. In combining various methods, special care must be taken to cover these deficiencies up resp. to improve the methods. Regarding the fact that the method of external fixation has in its indications for treatment numerous combinations, it is also more easily combined with other surgical methods. It proved successful in combinations such as: minimal osteosyntheses acc. to the AO method, additional immobilization in unstable osteosyntheses, in covering of extensive skin defects and soft parts with cross-leg and free grafts, in temporary osteosynthesis in extensive bone defects, in large diastases of public bones and lesion of the posterior urethra, in polytrauma for temporary bone immobilisation, in bone fractures and "compartment syndrome". The analysis of 38 cases shows that our decision was correct, since no unfavourable results were obtained.

External Fixators↗
PubMed2006

A hinged external fixator for the elbow.

OBJECTIVE: Stabilization of the ulnohumeral joint against rotation and shear forces, preserving flexion and extension movements, in order to safeguard the healing of the collateral ligaments. INDICATIONS: Persistent instability of the elbow joint in 90 degrees flexion following elbow dislocation, particularly in the anteroposterior direction; dislocation fractures; arthrolysis and graft arthroplasties; closed distraction arthrolysis. CONTRAINDICATIONS: Local infection in the area of the planned Schanz pins, uncertain position of the neurovascular structures, and lack of experience with the external fixator. SURGICAL TECHNIQUE: Determination of the joint axis through the capitulum of the humerus and the trochlea. Insertion of a 3-mm Kirschner wire (reference pin) in the center of rotation. Insertion of the humeral and ulnar Schanz pins under direct vision from the lateral or medial aspect. The lateral humeral Schanz pins are inserted in the distal humerus dorsal to the radial nerve. Removal of the reference pin. Symmetrical distraction of the ulna 2-3 mm from the joint surface of the humerus with the aid of the distractor. POSTOPERATIVE MANAGEMENT: No immobilization, immediate start on active and passive physiotherapy under plexus anesthesia, depending on the soft-tissue situation, individual pain, and the extent of the surgical procedure. RESULTS: The case histories of ten patients treated for persistent instability of the elbow at 90 degrees flexion or for an old dislocation of the elbow between April 2001 and March 2003 were studied retrospectively. The average age was 51 years (40-62 years). In seven patients internal fixation of the elbow had to be performed, six of which were treated initially with an AO fixator. After an average of 8 days the management was changed to hinged fixation. The median Mayo Elbow Function Score was 78 points with two very good, three good, and five satisfactory results. Subjective satisfaction on the DASH Score (Disabilities of Arm, Shoulder and Hand) revealed a slight reduction by an average of 18 points.

Adult↗
PubMed2007

Rigid external fixation and condylar remodeling.

Condylar fractures, instead of other mandibular fractures, play a primary importance role because their high incidence and the historic controversy existent in literature regarding their treatment. Recent studies prove that conservative treatment of condylar fractures, although not determining perfect alignment of the fractured segments, leads to a series of histologic and morphologic healing processes ending with consolidation of the fracture and functional recovery of the TMJ (temporo-mandibular joint). In this study, we observed long-term results of 2 cases of bicondylar fracture treated with surgical reduction and rigid external fixation. Rx orthopantomography control 1 year after surgery showed condylar remodeling bilaterally with good functional recovery. Our school affirms that semirigid fixation system allows optimal function between the articular head and the glenoid fossa, with good tridimensional repositioning of the fractured segments.

Adult↗
PubMed1987

Complications of external fixation of open fractures of the tibia.

Forty-two cases of open fractures of the tibia treated by external fixation are presented. Forty-three per cent of patients developed sepsis around one or more pins. Pin track sepsis occurred in 78 per cent of cases involving transfixion pins through muscle and bone but in only 17 per cent of cases using transcutaneous half-pins. Malalignment of more than 5 degrees in any plane was seen in 38 per cent of cases, almost half of which increased in plaster after removal of the fixator.

Adolescent↗
PubMed1983

External fixation for redislocated Colles' fractures.

Rereduction was carried out in 5% of all treated Colles' fractures and they were externally fixated with a one-bar Hoffmann apparatus. The results of 57 of the first 69 patients treated with a follow-up time of at least 1 year are presented. Using Frykman's criteria, 18 patients were judged as "excellent", 25 as "good" and 14 patients were judged as "unsatisfactory". The anatomical analysis showed no increase of deformity during the fixation. The final mean results were a 3.0 mm radial shortening and the articular plane of the radius at a right angle to the long axis. Among the first patients, five cases of pin-loosening were seen, but there were no adverse effects in the final result. There were no pin-tract infections. The results justify using the method as a routine when a redislocated Colles' fracture is rereduced.

Adult↗
PubMed1990

[Comparative theoretical study of various external fixation devices for the stabilization of distal radius fractures].

In the treatment of comminuted Colles' fractures different types of external fixation devices are used. Three main types are compared: (1) Fixation with two pins in each plane: Ace-Colles' type; (2) fixation with four or more parallel pins in one plane: Wagner/Hoffmann type; (3) fixation with four pins in one plane, two pins on each side of the fracture forming an angle of 60 degrees: ASIF-type fixator. These three types are compared with reference to the different forces that have to be neutralized by the seating of the pin in the bone. To minimize these forces with the aim of preventing pin-loosening, the theoretical results are used as the basis of practical surgical advice: (1) The distance between skin and fixator should be as short as possible. (2) The fixator should be fixed as close as possible to the fracture. (3) The diameter of the pins should be as great as possible. (4) If more than two pins per plane are used (Hoffmann/Wagner type), the pins should be wide apart. (5) If only two pins per plane are used (Ace-Colles Type) the bending stress on each pin is high (6) If more than two parallel pins per plane are used (Hoffmann/Wagner type), the axial forces on each pin are high. (7) The pins should be fixed at right angles to the fractured bone. Pins at other angles do more harm than good.

Biomechanical Phenomena↗
PubMed1992

Dynamic external fixation for stabilization of nonunions.

Twenty-five long-bone nonunions were stabilized until healing with a dynamic axial fixator (DAF). Seventeen cases were culture positive and ten had open draining wounds. Five cases had segmental gaps larger than 3 cm. In addition to the DAF, infected atrophic cases received debridement, coverage, and bone graft. Cases with segmental gaps were usually treated with massive posterolateral grafts to create a tibiofibular synostosis. Hypertrophic cases received only compression and weight bearing. Bone grafts were performed in 14 cases. The DAF was usually removed after 16-24 weeks of treatment. Twenty of the twenty-five cases were healed at DAF removal and required no further intervention. Nine of the ten hypertrophic cases healed in an average of 18.1 weeks without graft. Thirteen of 15 atrophic cases were bone grafted. Cases with segmental gaps larger than 3 cm were treated with prolonged external fixation to protect maturing grafts, but were still subject to stress fracture after fixator removal.

Adult↗
PubMed2002

Replantation of a crush amputation of distal tibia followed by lengthening with Ilizarov circular external fixator: two-year follow-up.

A 20-year-old male sustained a severe crush injury to his left leg, resulting in amputation of the foot at the level of the distal tibia. Despite 12-h warm ischemia, replantation was attempted after radical debridement, bone shortening, and proximal fasciotomies. The replanted part survived totally. Four months later, a 13-cm shortness of the extremity was managed by 10-cm lengthening with distraction osteogenesis, using Ilizarov's circular external fixator and by means of a special shoe. Two-year follow-up of the patient revealed acceptable functional and sensorial recovery. Success of replantation despite the excessive warm-ischemia time was attributed to the sparse muscle content of the distal tibia and foot. Fasciotomies performed on the proximal segment of the leg ensured the patency of anastomoses by maintaining adequate blood flow distally despite increasing edema after the crush injury. Debridement and bone shortening at the proximal stump eliminated the vein and nerve grafts to bridge the gap. In conclusion, considering the functional outcome of our case, replantation of distal parts of a lower extremity should be attempted first, even if the nature of the injury is unfavorable and the ischemia time is longer than the documented ischemia-tolerance.

Adult↗
PubMed2005

Unstable slipped capital femoral epiphysis: reduction by gradual distraction with external fixator. A case report.

Severe unstable slipped capital femoral epiphysis (SCFE) usually requires some form of reduction before stabilization to avoid loss of motion and to prevent the development of early degenerative arthritis. Gentle manipulation and traction is being used to achieve reduction. The force applied with these techniques is uncontrolled and unpredictable, and may add to the pre-existing risk of avascular necrosis of the femoral head in such cases. The authors report a case of acute on chronic, severe, unstable SCFE in which reduction was satisfactorily achieved by gradual distraction using an external fixator across the hip joint. The patient did not show signs of avascular necrosis or chondrolysis at a follow-up of 38 months. Hip function was excellent with Iowa hip score of 98 at the final follow-up.

Cartilage, Articular↗
PubMed2006

Application of circular external fixator under arthroscopic control in comminuted patella fractures: technique and early results.

BACKGROUND: Comminuted fractures of the patella are traditionally treated by internal fixation. The modified tension-band technique is widely accepted for internal fixation. The management of comminuted fractures often requires additional K-wire and/or circlage material and wide surgical exposure. Therefore, symptoms and complications related to the stainless steel wire are not uncommon in these cases. We present a new alternative treatment technique for comminuted patellar fractures. METHODS: Five comminuted patellar fractures of four patients were treated by circular external fixator (CEF) under arthroscopic control. The mean patient age was 32.5 (range 24-41) years and mean follow-up was 22 (range 20-28) months. RESULTS: In four cases, union was completed by the sixth week; in the other case, union was completed by the eighth week. The frames were removed after union of the fracture was documented. When the CEF was removed, full knee range of motion was observed full in all patients, and the patients returned to their normal activities of living in a few days. The mean Lysholm score was 94 (range 85-100) after treatment. CONCLUSIONS: CEF application under arthroscopic control can help avoid some complications of the traditional treatment methods, particularly in comminuted fractures of the patella. The most important advantage of this technique is to allow active knee motion in the early postoperative period so patients can return to activity of daily living soon after the implant removal. In addition, arthroscopic examination of the knee joint provides an assessment of any other intra-articular lesions. This technique allows healing of the fracture with low morbidity.

Adult↗
PubMed2002

Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy.

The ulcerated foot in individuals with Charcot neuroarthropathy presents a complex problem when correction of the deformity is necessary but the presence of infection precludes the use of internal fixation. We reviewed 11 patients with midfoot Charcot neuroarthropathy, collapse, and ulceration who were at risk for amputation. These patients underwent operative debridement, corrective osteotomy, external skeletal fixation and culture-directed antibiotic therapy as a limb salvage procedure. Patients were transitioned from the external fixator (average 57 days) to total contact casting (average 131 days) and all subsequently progressed to therapeutic footwear in 12 to 49 months of follow-up (average 24 months), except one patient whose medical decline resulted in bedrest. We believe that when performed in properly selected patients, this procedure presents an alternative to amputation and, via corrective osteotomy, results in a shoe-able, functional foot that is potentially less prone to ulceration.

Adult↗
PubMed1996

[Anatomical and functional results of the external fixation of upper metaphyseal tibial fractures].

PURPOSE OF THE STUDY: This study aimed to evaluate a method for the treatment of upper tibial metaphyseal fractures using an external epiphysodiaphyseal fixation with the double-frame Hoffmann device. MATERIALS AND METHODS: The study included 48 patients (37 men and 11 women) aged 16 to 82 years. The tibial fracture was simple in 15 cases, included a metaphyseal comminution, partial in 3 cases and total in 30. In 13 patients, there was also a simple articular fracture. The fracture was opened in 24 cases (type I in 10, type II in 7 and type III in 7 cases). METHODS: The gap and displacement evaluation between the fragments after reduction was made on postsurgical roentgenograms; its was considered as complete when all fragments were in contact with each other, without frontal or anteroposterior translation above 5 mm. Healing was defined as a complete bone continuity providing a painless load bearing. The patients were clinically and radiologically reexamined with a mean follow-up of 15.45 months (5 to 62 months). RESULTS: After healing, there were 2 cases of angular deformities in patients whose autonomy was otherwise already reduced. Twenty-three patients had a minor pin tract infection. There was 3 cases of secondary osteitis after a type-III open fractures and 3 other deep septic complications without functional consequences. Forty-one fractures healed without bone graft in a mean time of 18 +/- 7.6 weeks. Healing did not seem to statistically depend on the opening nor on the type of fracture, but rather on the association with a peroneal fracture and the loss of cohesion between the fragments. The duration of professional invalidity evaluated in 20 cases, varied between 4 to 21 months (means: 11.3 months), and none of the patients had to modify his activity because of the tibial fracture. At follow-up, no patient complained of invalidating pain. Thirty-two patients recovered a satisfactory knee joint mobility and among the 16 others, in only 3 no particular reason was found to explain the deficit. DISCUSSION: While good anatomic and functional results lead us to keep the principle of external fixation, it seems however necessary to modify the modalities of the treatment in order to improve healing conditions, especially by improving the cohesion of the fragments through secondary minimal internal fixation. The use of dynamic axial fixation devices could therefore bring a theoretical advantage, but it must be proven that they produce in this site a primary stabilization which is a good as that obtained with Hoffmann's device.

Adolescent↗
PubMed1995

[Classification and osteosynthesis technique of calcaneus fractures. External fixator as temporary distractor].

In the treatment of fractures of the calcaneus, the particularly intricate local anatomy, complicated fracture forms and associated soft tissue damage often prejudice operative, anatomical reconstruction. We propose a simplified classification that is based on the Regazzoni classification of 1993 and has six grades of severity. It can be helpful in the selection of operative treatment and, above all, make it possible to recognize whether operative reconstruction is possible and appropriate. When operative reconstruction is indicated we find the secondary operation important; it is also important to diagnose and treat compartment syndrome if present and otherwise to take steps to prevent it. In the first phase, in special cases we use an external fixator without reconstruction of the full length. The operative technique is largely standardized as as the fixator is placed only temporarily. Correct positioning allows easy correction of shortening or varus deformation, and joint surface reconstruction is also feasible. Autologous bone grafting is possible. The definitive fixation is achieved with internal plate stabilization by a lateral approach and removal of the fixator. Contraindications for this procedure are burst fractures with total destruction of the joint surfaces and cartilage. Out of 54 fractures we used the fixator to aid reduction in 45. In 71% of these we had very good and good results according to the Merle d'Aubigné scoring system.

Adult↗
PubMed1985

External fixation of the leg using unilateral biplanar frames.

A simple and reliable method is described for testing the stability of external fixators under stresses similar to those found in clinical practice. Unilateral uniplanar, unilateral biplanar, and bilateral uniplanar frames were used. It seemed important to measure deformations under bending stresses in different planes, because we have found a variable rigidity in some of the frames in the different planes. Our results show that a unilateral biplanar frame without transfixation pins can be set up with an overall rigidity as good as that of a bilateral frame. Using this on the leg, one can avoid putting pins through the anterolateral compartment.

Evaluation Studies as Topic↗
PubMed2004

Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent.

INTRODUCTION: Pin site infection is the most common complication using external fixators. This study investigated the differences in pin site infections, antibiotic use, pain, and complications using sodium chloride and chlorhexidine solution as cleansing agent in patients operated on by the hemicallotasis technique for knee deformities. MATERIALS AND METHODS: The prospective study included 49 consecutive patients: 2 mg/ml chlorhexidine solution was used as cleansing agent in 30 patients (120 pins) and 9 mg/ml sodium chloride in 19 patients (76 pins). We evaluated the status of the pin sites, pain (VAS), uses of antibiotic and analgesic agents, and any complications (infections were graded according to the Checketts-Otterburns classification). Bacterial cultures were performed from each pin site at 1, 6, and 10 weeks and from the pins at removal. RESULTS: Grade 1 infection was found in 14% of the sodium chloride group and in 8.5% of the chlorhexidine group, and grade 2 infection in and 3% and 0.5%, respectively. With sodium chloride there was a significantly higher relative risk for positive cultures (1.7) and for the presence of Staphylococcus aureus (3.3). The chlorhexidine group required significantly fewer antibotics reported significantly less pain at weeks 6 and 10. CONCLUSIONS: Chlorhexidine solution (2 mg/ml) as cleansing agent in pin site care is preferable to sodium chloride in patients operated on by the hemicallotasis technique.

Adult↗
PubMed1990

Early clinical experience with Orthofix external fixation of complex distal radius fractures.

Twelve patients with complex fractures of the distal radius were treated with the Orthofix external fixation system (EBI Medical Systems, Fairfield, NJ). On follow up physical examination, the average wrist dorsiflexion was 46 degrees, and the average volar flexion was 55 degrees. The average grip strength in the involved hand was 38 lb force. The average final radial angle was 18 degrees, and the average residual radial height was 12 mm. Average volar tilt was 3 degrees. The complication rate was 42%. Very rigid axial stability is afforded by the fixator, but the large 3.5 mm tapered bone screw diameter precludes redrilling for screw adjustment. The apparatus needs frequent monitoring to reconfirm the security of the locking nuts and cam mechanisms, and the Orthofix system can be reused only four times.

Adolescent↗